Erroneous Denial of Mammography Claims

The Department of Health Care Services (DHCS) is aware of a claims processing issue causing Medi-Cal and Every Woman Counts (EWC) mammography claims billed with the following CPT codes; 77052 Computer-aided detection with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography, 77063 Screening digital breast tomosynthesis, bilateral , 77057 Screening mammography, bilateral and G0202 Screening mammography, producing direct digital images, bilateral, all views, to erroneously deny with Remittance Advice Details (RAD) code 0095: This service is not payable due to a procedure, or procedure and modifier, previously reimbursed. This issue affects claims for dates of service on or after September 1, 2013. DHCS will notify providers when the issue is resolved. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC).